Trombosis arterial y venosa masiva / Massive Arterial and Venous Thromboses

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Retroneumoperitoneo por espondilodiscitis fulminante / Retropneumoperitoneum due to fulminant spondylodiscitis

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Postoperative Care in Kidney Transplantation: A Comparison Between Controlled and Uncontrolled Donation After Circulatory Death.

Recent research in kidney transplantation has revealed differences in the evolution of renal function among patients transplanted from 2 alternative programs for donation after circulatory death (DCD). A retrospective, observational, single-center study was carried out from 2013 to 2016 at a level III hospital intensive care unit (ICU) to assess the progression of kidney recipients after transplants from uncontrolled DCD (uDCD) or controlled DCD (cDCD). The following variables were collected for data analysis: demographics, comorbidities, type of donation, lactate, hemoglobin and glucose levels at ICU admission, creatinine concentration at ICU admission, at-hospital ward transfer, at-hospital discharge, radioisotope imaging results, ICU and in-hospital length of stay, and mortality. There were 87 patients eligible for analysis, 42.5% of which were uDCD recipients. Improvement in kidney function was significantly delayed after uDCD compared with cDCD. A multivariate analysis showed that both uDCD and lactate levels at ICU admission increase the risk of poor outcome after renal transplantation. No deaths were registered in either patient group. Our results suggest that kidney transplantation recipients from uDCD recover renal function at a slower rate than patients transplanted from cDCD, a factor that does not affect mortality.

Living Donor in Renal Transplantation: Minimizing Risks.

In recent years, the broadening of indications for renal transplantation, together with the progressive reduction of donations following brain stem death, has led to living donation being considered in increasing numbers of cases for renal transplantation. To investigate this further, it is necessary to assess the impact it has on the postoperative outcomes in the intensive care unit (ICU). Our group conducted a retrospective, observational, single-center study from 2013 to 2016 to evaluate differences in outcomes between living and cadaveric kidney donation both during ICU admission and total hospitalization. We compared differences in characteristics between living and deceased graft recipients including demographics, comorbidities, analytical data, radioisotope imaging test results, complications, ICU and hospital ward length of stay, and mortality. In all, 387 patients were eligible for analysis, and 13% received living donor grafts. Our results demonstrate that this group had significantly fewer complications, shorter length of hospital stay, and reduced mortality in comparison with recipients of cadaveric donor grafts. The better postoperative outcomes from living donor grafts could result from careful selection of the donor and less inflammatory injury, minimizing risk in the postoperative period.

Cold Ischemia Time as a Factor in Post-transplantation Complications for Orthotopic Hepatic Transplantation.

OBJECTIVE: This study aims to compare a shorter cold ischemia time with the present one in relation to the complications developed in liver transplantations. DESIGN: This is a retrospective, observational study of orthotopic liver transplantations performed with grafts from brain-dead donors during 12 months at a University Hospital (Seville). We compare incidence rates of complications (reperfusion syndrome, arterial and biliary complications, and prostaglandin requirements) between two groups according to cold ischemia times (group A < 6 hours; group B > 6 hours). RESULTS: Sixty cases were included. There were more males in both groups as donors (55.5%) and recipients (75%). The median age was higher in group B in two cases. The Model for End-stage Liver Disease score was higher in patients with a shorter cold ischemia time, with a median of 20 hours (range, 16 to 26.5 hours). We observed that reperfusion syndrome (3.4% vs. 13.3%; P = .353), vascular complications (6.9% vs. 24.1%; P = .144), biliary tract complications (13.8% vs. 20.7%; P = .730), and prostaglandin requirements (3.4% vs. 20.7%; P = .102) were more common in group B, although without reaching statistical significance. After uni- and multivariate analyses, cold ischemia time longer than 6 hours was the only risk factor to develop complications (odds ratio: 3.578; 95% confidence interval: 1.125 to 11.374, P = .031). CONCLUSION: According to the results of our analysis, cold ischemia times longer than 6 hours, as tends to be the usual procedure in most centers, imply higher rates of complications after liver transplantation.

Orthotopic Liver Transplantation: Preliminary Analysis of Complications With Grafts From Elderly Donors.

OBJECTIVE: This study aims to determine if donor grafts of patients older than 65 years develop more post-transplantation complications than those of younger patients. DESIGN: This is a retrospective, observational study of liver transplant recipients during 12 months in Virgen del Rocio University Hospital. We compare incidence rates of reperfusion syndrome, acute kidney injury, and need for intra- and postoperative red blood cell transfusions in two donor age groups in which group A is <65 years old and group B is ≥65 years old. RESULTS: Sixty cases were included. Reperfusion syndrome, acute kidney injury, and both intra- and postoperative red blood cell transfusion were more frequent in group A than group B (11.4% vs. 4%, P = .390; 44% vs. 32%, P = .423; 68.8% vs. 48%, P = .120; and 70.6% vs. 64%, P = .779, respectively). Six recipients (17.1%) died at 12 months from group A whereas there were no deaths register in group B during that time (P = .036). CONCLUSION: Our results showed that including elderly donors does not aggravate incidence of complications, emphasizing that advanced age should not be an exclusion criteria for liver transplantation.

Miocarditis fulminante asociada a influenza A / Fulminant myocarditis associated to influenza A

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Severe rhabdomyolysis after allogeneic transplantation of facial structures: a case report.

We present a patient with panfacial neurofibromatosis type 1 who underwent allogeneic transplantation of facial structures, which was complicated by severe rhabdomyolysis and temporary oligoanuria. Because of his underlying disease, this 35 year-old man, weighing 68 kg and with a body mass index (BMI) of 27, had undergone 17 operations for resection modeling of hypertrophied tissues, either alone or combined with static suspension techniques. He finally underwent allogeneic transplantation of facial structures. In the early hours of the postoperative period, in the context of a systemic inflammatory response syndrome, he experienced severe rhabdomyolysis, with elevation of the muscle enzyme creatine kinase producing a minor impact on kidney function. The patient was discharged home at 12 weeks after the transplantation.

Efficacy and safety of mycophenolate mofetil as part of induction therapy in liver transplantation.

AIMS: To report our experience with mycophenolate mofetil (MMF) for induction and maintenance therapy to prevent acute liver transplant rejection. METHODS: A retrospective analysis of 66 elective, noncombined liver transplant patients treated beginning de novo MMF and follow for a minimum of 2 years. Thirty-nine of the 66 cases received MMF, calcineurin inhibitors, and steroids. In 11 cases daclizumab was added; in 16 daclizumab was added without steroids. RESULTS: The global survival rate was 91% at 6 months, 89.4% at 1 year, and 87.9% after 2 years. Acute rejection episodes were observed in six patients (9.1%). All episodes responded to corticoids. Toxicity possibly, probably, or partially related to MMF was observed in 35 patients (53%) with definitive suspension required in 13 cases (20%), with dose reduction or temporary suspension in 22 (33%). Hematological toxicity associated with MMF was observed in 12 patients (18%), leading to definitive suspension in two patients (3.03%), temporary suspension in two cases (3.03%), and dose reduction in eight cases (12%). Opportunistic infection was observed in seven cases (10%). Gastrointestinal toxicity was mild and infrequent (five cases, 7.5%). CONCLUSION: Regimens containing MMF reduce rejection episodes with high survival rates and low toxicity.